{
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"IsOrgSubpart": "N",
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"OrgName": "TIFTAREA ENDOSCOPY CENTER, INC.",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "907 E. 18TH STREET",
"SecondLineMailingAddress": "SUITE 460",
"MailingAddressCityName": "TIFTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31794",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-391-3625",
"MailingAddressFaxNumber": "229-391-3639",
"FirstLinePracticeLocationAddress": "907 E. 18TH STREET",
"SecondLinePracticeLocationAddress": "SUITE 460",
"PracticeLocationAddressCityName": "TIFTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-391-3625",
"PracticeLocationAddressFaxNumber": "229-391-3639",
"EnumerationDate": "07/03/2006",
"LastUpdateDate": "07/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAWSON",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "229-391-3625",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "136-156",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}